Emergency Rent/Eviction Prevention Loan Application

Emergency Rent/Eviction Prevention Loan Application

JEWISH FREE LOAN — 12701 N Scottsdale Rd. Suite 206, Scottsdale, AZ 85254
Thank you for your interest in Jewish Free Loan. JFL’s interest-free loan program is available to:

-Residents of Arizona

-You must be at least 18-years-of-age

-A part of the Jewish community

Please complete the secure application form below and a member of the JFL staff will be in touch as soon as possible regarding your application and next steps.
Are you part of the Jewish community?*

YesNo
How did you hear about the Jewish Free Loan?*
Amount Requested*
Reason for loan request (brief description)*
Applicant Information
Legal Name*

First NameLast Name
Preferred Name*
Maiden Name or AKA
Pronouns*

She / HerHe / HimThey / ThemPrefer Not to AnswerOther
Applicant Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Applicant Cell Phone*

Area CodePhone Number
Applicant Work Phone

Area CodePhone Number
Applicant Primary Email Address?*
All future documents and communication will be sent to the email provided on this application.
Social Security Number*
Driver's License Number*
Date of Birth*

MonthDayYear
Date
City and State of Birth*
City, State
U.S. Citizen*

YesNo
If foreign born, emigrated from*
Country
In U.S. since*
Year
In Arizona since*
Year
Marital Status:*

SingleMarriedDivorcedSeparatedWidow/WidowerDomestic Partner
Have you or your spouse ever applied for a loan from JFL?*

YesNo
Have you or your spouse ever received a loan from JFL?*

YesNo
When?:*
Date
Have you or your spouse ever co-signed for a loan from JFL?*

YesNo
For whom?*
Name
Applicant Employment Information
Applicant's Occupation (if retired, previous occupation)*
Yearly Gross Income*
Name of Employer*
Employed Since:*
Employer Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Employer Phone Number

Area CodePhone Number
Applicant Financial Information

Please complete information for your bank(s).*

	Name of Bank	State	Type of Account
1
2
3

Please list your assets.*

	Assets (savings, securities, car, property equity, etc)	Amount
1
2
3

Please list your average monthly income & expenses. *

	Average Total Per Month
Income
Expenses

Please summarize your income and expenses.*

	Source of Income	Monthly	Yearly	Source of Expenses	Monthly	Yearly
1
2
3
4
5
6

Other Sources of Income*
Other Sources of Expenses*
Applicant Lease/Mortgage Information
Do you rent or own your place of residence?*

RentOwn
Monthly Rent/Mortgage*
How long have you lived at this address?*
Please upload the first page of your lease.*

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Please upload any information you have regarding your leasing agency's policy on partial payments and third party payments. This can be found in your lease.

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Do you have an eviction notice?*

YesNo
Please attach your eviction notice here. *

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If you have late fees attached to your rent, please upload the most current bill or notice showing said fees.

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Have you applied for rental assistance from any other source?*

YesNo
What is the status of your rental assistance request?*
Have you contacted Jewish Family & Children Services?*

YesNo
What is the status of your Jewish Family & Children Services application?*
Spouse and Dependent Information
Spouse's Name*

First NameLast Name
Spouse's Maiden Name
Relationship to borrower applicant*
Husband, Wife, or Domestic Partner
Are they Jewish?*

YesNo
Spouse's Date of Birth*

MonthDayYear
Date
Spouse's Cell Phone*

Area CodePhone Number
Spouse's Work Phone

Area CodePhone Number
Spouse's Primary Email*
All future documents and communication will be sent to the email provided on this application.
Spouse's Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Spouse's Social Security Number*
Spouse's Driver's License Number*
Spouse's Occupation*
If retired, previous occupation
Spouse's Yearly Gross Income*
Name of Spouse's Employer*
Spouse Employed Since:*
Number of Dependents*
Please provide the names, ages, and relationship of any dependents. *
Emergency Contact

Emergency contact other than spouse/partner.
Name of Emergency Contact*

First NameLast Name
How do you know them?

Relative (not spouse/partner)Friend
Emergency Contact Phone Number*

Area CodePhone Number
Is there any additional information that was not addressed through this application that you would like to include?*
Type N/A if none
Certification of Completeness and Accuracy, and Approval to Obtain Additional Information
- I authorize Jewish Free Loan to investigate my credit and personal history.
- I authorize agencies and persons contacted by Jewish Free Loan in connection with this application (including credit reporting agencies, banks, and social service organizations) to provide information about my credit and personal history to Jewish Free Loan.
- I certify that the information contained in this loan application is complete and accurate.
Applicant's Signature*

Clear
Please draw a full signature in the box above. If you are using a mouse: click inside the box, continue holding your mouse button down and drag your cursor to draw. If you are on a tablet: hold your finger inside the box and drag your finger to draw.
Date*

MonthDayYear
Date
Spouse's Signature*

Clear
Please draw a full signature in the box above. If you are using a mouse: click inside the box, continue holding your mouse button down and drag your cursor to draw. If you are on a tablet: hold your finger inside the box and drag your finger to draw.
Date*

MonthDayYear
Date
Borrower's Acknowledgement of Terms and Conditions

I understand and agree that the following terms and conditions will apply to my loan:
- There will be no interest charged.
- The cost of obtaining a credit report will be deducted from the proceeds of the loan.
- I will repay my loan according to the amounts and schedule stated in the promissory note that I sign.
- If I fail to make payments as agreed, Jewish Free Loan will start collection proceedings against me and my guarantors (each of whom is individually responsible for the full amount of the outstanding balance).
- I will immediately notify Jewish Free Loan about any changes in my address or in my ability to make my payments as agreed.
- I am signing this document individually.
- No Power of Attorney will be accepted.
Applicant's Signature*

Clear
Please draw a full signature in the box above. If you are using a mouse: click inside the box, continue holding your mouse button down and drag your cursor to draw. If you are on a tablet: hold your finger inside the box and drag your finger to draw.
Date*

MonthDayYear
Date
Please upload an image of your Photo ID (drivers license, passport or state ID)*

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Application can be submitted without a photo ID. However, your application will not be processed until a copy of your photo ID is received by the JFL office. Cancelof
Spouse's Signature*

Clear
Please draw a full signature in the box above. If you are using a mouse: click inside the box, continue holding your mouse button down and drag your cursor to draw. If you are on a tablet: hold your finger inside the box and drag your finger to draw.
Date*

MonthDayYear
Date
Please upload an image of your Photo ID (drivers license, passport or state ID)*

Browse Files

Cancelof
Should be Empty:

Emergency Rent/Eviction Prevention Loan Application

Applicant Information

Applicant Employment Information

Applicant Financial Information

Applicant Lease/Mortgage Information

Spouse and Dependent Information

Emergency Contact